These case studies were compared on their pre- and post-neuropsychological assessment in order to evaluate treatment outcome. Two middle aged females with normal premorbid histories each sustained severe brain injury, one from a lightening bolt with consequent anoxic encephalopathy (AE); the other from motor-vehicle accident with a resultant bitemporal lobectomy (BL). Both received 6 months of outpatient cognitive rehabilitation 4 days per week following 3 months of acute care and hospitalization. As measured by pre- and postscores on the WAIS-R, WMS-R, WRAT-R and selected subtests of an expanded Halstead-Reitan Neuropsychological Battery, the patient with sustained AE showed very little improvement following treatment, whereas the patient with BL made considerable gains in visual immediate recall, attention/concentration, confrontational naming, speech sounds, verbal concept formation, and tactile-perceptual processing speed. The patient's remarkable gains in visual immediate recall, (an increase of greater than 2 standard deviations), significantly exceed natural recovery expectations, and correspond to the objectives of her rehabilitation program. This study suggests that patients with BL may be more amenable to cognitive rehabilitation than was previously believed, while patients with AE may be more limited in their potential for recovery.